Health and Psychology

All over the television are ads designed to get patients to ask their physicians about whether specific medications may be "right" for them.  This type of direct marketing is influencing patient care, and is starting to creep into hard news stories where the the info-tizing (advertizing presented as information) may be confusing to some patients.

A recent news story on women's health was promoting the use of a specific lab test to evaluate heart disease.  The information certainly was not up to date, was promoting a specific lab test, and was exceeding the actual advantages of the test while failing to mention any disadvantages and going well beyond what the test is reported to be able to do in research studies.

Heart disease is certainly a problem for women.  If there is a family history of heart disease, it makes sense to perform a thorough cardiovascular evaluation including lab studies.  So what would that consist of and when should it be done?  That would depend on the family history.  In my biological family, every single person on my mother's side of the family has a heart attack prior to age 50.  Every person survives the initial heart attack and either dies of a later heart attack or a stroke or complications of another illness.  So the goal for me, my sister, and brothers would be in attempting to prevent an initial heart attack and lessen the risks.  Screening for heart disease began for me in my 20's.  The screening began with basic lab tests called a complete blood count, metabolic panel, and tests for cholesterol and triglycerides and other fats known as lipids in the blood.  I had a baseline electrocardiogram.  Blood pressure, pulse, and termperature were taken and monitored during all routine visits.

The second stage of screening involved having a treadmill stress test.  This was done not only because of my family history, but because of abnormalities found on the initial electrocardiogram.  If I was symptom free-and there were no abnormalities, this part could have been postponed until I was in my 30's or 40's. 

I started developing cardiovascular symptoms in my late 30's early 40's. I was short of breath and my blood pressure wasn't well regulated.  The third stage of screening involved taking a close look at how my heart was functioning.  I had nuclear scans of my heart, and more extensive laboratory studies.  These included some specialty lab studies for markers correllated with heart disease.  The markers measure inflammation of the body in general.  Lifestyle changes and some mediations have been shown to reduce these markers and have been thought to lessen the risk of heart disease progressing to heart attack.  At the time I was offered more invasive testing to allow my cardiologist to see the blood vessels to and from my heart (an angiogram).  Because of some unusual medical problems, (I'm predisposed to complications of excess bleeding and infection), I declined any invasive testing as too risky. 

I'll continue to have episodic monitoring of my heart for the rest of my life.  Taking steps to reduce my risk factors apart from genetics is the goal of all monitoring and any treatment.  In my case, limiting infections, reducing episodes of excess bleeding, going on a diet that reduces gluten and therefore reduces my inflammation, and controlling blood pressure are specific individualized treatment plans.  For my husband, who also has a family history of heart disease, lowering cholesterol, reducing fat and increasing vegetable based carbohydrates, losing weight, controlling blood pressure, and increasing exercise is his individualized treatment plan.  For one of my brothers the plan is controlling his diabetes and getting drug eluding stents to open blocked blood vessels, taking a statin medication to lower cholesterol, and an aspirin to thin his blood and lessen the risks of stroke due to clotting.  Although the goal for each of us is to reduce risks, the actual treatment varies considerably.

The internet and television can be useful sources of information about healthcare, but it's important to understand what specific treatments are available, and what treatments are best for you as an individual based on your history, health risks, and current medical information.